SWBH NHS Trust Heartbeat March 2014 by abigailparkin

He rtbeat March 2014

The pulse of community health, Leasowes, Rowley Regis, City and Sandwell Hospitals

Issue 65

First impressions matter

Hundreds of thousands of times a year, we deliver an outpatient appointment. It is by far the most common thing that we do. Usually, the experts, notes, scans, and test results are all in place. An effective discussion takes place, we meet the patient’s expectations and our own. But we want outpatient services to be the very best part of what this Trust provides. Consistently exceeding expectations - that is not the current state. That is why this year will see an overwhelming focus on

outpatient care. Changing some systems to make them more consistent. Talking with patients before their appointment and using new technology to keep in touch with them between clinics. Trying to reduce the amount of expert time in some specialties spent in clinic, if other professionals can step in or we can work differently with GPs, dentists, optometrists and pharmacists. Making sure that what was said in clinic was truly understood by the people we serve. Chief Executive, Toby Lewis, told Heartbeat: “This year must mark a big change in the profile and the esteem of

outpatients at the Trust. Everyone has a part to play. “As we change how we deliver outpatient care, then other teams will need to adapt how they work too. “The key metric is what patients think - do they tell us we did a great job? “We will be investigating and publishing that, at site, directorate and clinic level in the year ahead. “We need to celebrate the very best of what we do, much more widely and loudly. “We want to support teams to change traditional clinic models to suit clinical need.”

Year of Outpatients - Innovations from around SWBH Helping adults who stammer

One stop multidisciplinary allergy clinic

Rapid Hydration Clinic

Since May 2013 the Speech and Language Department has introduced therapy in a small group setting for adult stammers in Sandwell, aimed at maximising potential change, reducing avoidance of speaking/social situations and providing opportunity for peer support Taking this approach increases the breadth of therapy options available to clients but also maximises service capacity, helping to reduce waiting time for therapy.

Children are benefiting from a ‘one stop’ visit to outpatients thanks to the opening of a multidisciplinary allergy/immunology clinic. Children can have their allergy diagnosed, appropriate medications prescribed, training given on how to recognise and treat an allergic reaction and a written management plan given. Clinical Director Dr Chizu Agwu explained: “This is particularly useful if a clear history of food allergy has been obtained on presentation to the GP, enabling the need for specific skin prick to be predicted.”

Pregnant women suffering an extreme form of morning sickness, called ‘hyperemesis gravidarum’, now have access to a rapid hydration clinic at City Hospital, which can help to make the first months of a difficult pregnancy more bearable. One patient, making her third visit to the clinic, which is situated at the rear of D42, was Mrs Samina Akhter of Handsworth. At 10 weeks pregnant Mrs Akhter has suffered almost constant vomiting, which has left her losing weight, dehydrated and feeling very poorly. She said: “Being able to come in here is great as it takes away the hassle of A&E. “I just have to call the unit, explain the situation and they tell me when I can come in.” Most patients stop on the unit for about six hours (reducing previous length of stay from up to 72 hours).

BMEC ensures children are not ‘lost’ The transition from paediatric to adult based hospital care can be a difficult one for both children and young adults with long term clinical conditions. BMEC is both looking into and implementing a number of means of ensuring that young patients don’t get ‘lost’ from consultant based care. Hilary Lemboye, Acting Group Director of Operations for Surgery B, said: “We already have a number of joint clinics at Birmingham Children’s Hospital (BCH) which support successful transition between paediatric and adult care and recently, we started a new one for young glaucoma patients.”

Rheumatology and long-term conditions Patients are benefiting from innovative work with GPs with a special interest (GPwSI) in musculoskeletal conditions who are based at practices in Handsworth Wood, Lyng and Regis Medical Centres. These GPs are able to triage cases and decide which need consultant input. As well as bringing the service for most patients closer to home or work it also allows prompt GPwSI referral onwards to physiotherapy and other paramedical services. Dr Karl Grindulis, Consultant Rheumatologist, said: “Most patients nowadays don’t need beds or special equipment but time and the correct medical and paramedical services, in other words do not require a hospital building but the right expertise in the right place.”

Outpatient Staff Nurse Kathryn Spittle with 11 year old Ahsaan Kumar doing an allergy prick test.

The Smethwick Pathfinder Specialist Diabetes Team The Smethwick Pathfinder Specialist Diabetes Team was runner-up in the Transformation category of last year’s Staff Awards for good reason. This community diabetes innovation devolves care for diabetes patients into the community where it is needed, increasing hospital capacity and as well as saving costs, improving patient care and satisfaction. Dr Parijat De, one of the leading members of this project, said: “There is good audit data from all these practices that diabetes control (HbA1c) has significantly improved over the years.”

Lynne Saunders and pregnant patient Mrs Samina Akhter.

Helping gastroenterology patients By purchasing a new device called a Fibroscan, we can now test the liver’s ‘stiffness’ and determine whether regular blood tests and biopsies are necessary for patients with fatty liver disease. Group Director for Medicine and Emergency Care, Dr Matthew Lewis, explained: “When we see a normal looking liver, it will mean that patients don’t need to come back to clinic for tests so often.” and much much more!

Across our Trust we want to deliver eight Outpatient Standards. To find out more visit: http://goo.gl/7Q3g4l

Welcome

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FROM THE CHAIRMAN... The importance of teamwork is a recurring theme across our Trust. We have plenty to celebrate - whether it’s the successful implementation of our Medically Fit for Discharge wards or our maternity services achieving Level 3 status or many other examples of best practice my Board colleagues see or hear about. Teamwork is a common denominator to all the areas where we’re making real progress - examples are our mortality reviews and work on improving our level of re-admissions. Our first patient safety summit gave huge emphasis on how successful team dynamics are essential to delivering world class safety standards. On March 10 we published our second Learning Alert – a two minute video about how our best teams communicate using team briefs. This was sent to all mailboxes but can also be seen via the following link: http://bit.ly/PnsTFC. All our best innovations and focus on delivering improvements to our effectiveness all demonstrate how teams which engender trust and openness make the most progress. Clearly the complexity of NHS services means many staff can be part of several teams. However the inter-dependency of the roles we all play and listening to all team member contributions is vital to create a cycle of continuous improvement.

If so please contact Editor Jo Messinger on 0121 507 5660 or email: swb-tr.SWBH-GM-Heartbeat@nhs.net For more SWBH news: @SWBHnhs

Richard Samuda, Chairman.

Metaphors from the sports field or all the most admired businesses and public services all reinforce the presence of that magic ingredient. Our leadership programme provides an important opportunity to focus on how, despite the constant pressure on the NHS, relentless application of this theme will bring real rewards in our continued momentum of success and in creating a working environment that stands out from our peers. Richard Samuda, Chairman.

Raising Change Day brings a the roof on touch of virtual reality homelessness MULTIPLE agencies gathered at the City Hospital Post Graduate Centre for the launch of an innovative patient intervention programme. The event, on February 28, brought together care providers from across Birmingham to help support patients challenged by homelessness. The programme was initiated after a £300,000 grant from the Department of Health to help improve homeless health services in the region. The Trust Homeless Pathway Team will work alongside GPs as well as social care providers to deliver a joined up service to significantly improve the aftercare that patients receive. The conference saw videos, discussion and insightful presentations as well as a unified commitment to provide high quality care for all.

Toby Lewis, Alex Bax (CEO of the Homeless Care Pathway) and CCG Chairman Dr Nick Harding.

DEPUTY Chief Nurse Linda Pascall has taken to the cyber world, in a bid to use the technology to get messages out to patients, visitors and staff. The trust has installed a life size hologram of Linda in the main receptions at City and Sandwell giving out messages on hand hygiene and infection prevention. Linda was also the face of the Trust’s campaign to get as many staff as possible to make a pledge for NHS Change Day on 3 March. She hosted a visit from Jackie Lynton, Head of Transformation, NHS Horizons Group - NHS Improving Quality, who visited Sandwell Hospital in February to meet staff and hear about the pledges they made. Linda commented: “I was delighted to take on the role of encouraging my colleagues to make their pledges in order to improve lives. “I’ve made several, including pledging to spend time every month feeding a patient who needs help to eat, and to shake the hand of every one of our ward service officers – our unsung heroes!” The Trust also created a

Heartbeat - March 2014

‘pledge tree’ which is sited in the main reception at Rowley Regis The Trust also adopted two organisation wide pledges. These are: • Adopt Kate Granger's 'Hello my name is...' campaign across the Trust with every contact we make starting with us saying hello and giving our first name. • Offer our patients an opportunity for them to tell their stories to drive up standards and recognise good practice. We will publish them on our website.

Linda Pascall meets her hologram.

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Financial year ends in the black but there is more to do in 2014-15 The Trust will end this financial year in surplus but the way it is being achieved cannot be repeated again, writes our new Director of Finance and Performance Tony Waite. The Trust will likely report a surplus of £6.7m for 2013/14. This will be the seventh consecutive year of surplus and will have been achieved at the same time as improving our standards of care and patient experience - a terrific result. That financial resilience and continuous improvement in the care we provide is precious and something we need to sustain. It is the key to our ambitious plans to become renowned as the best integrated care provider in the NHS and to securing a new hospital. It is also key to making SWBH a great and fulfilling place to work. Whilst the headline result for 2013/14 looks good there is devil in the detail. It is that detail which we need to address and change as we go forwards. In 2013-14 the majority of clinical directorates and some corporate directorates will spend more than their budget. Importantly, some of that over spending reflects unidentified and undelivered savings and an over reliance on expensive agency staff. This over-spending will be bailed out by a reliance on some directorates under spending their budgets and by using up our reserves. That is not a basis for sound and sustainable finances. The financial outlook for the next two years is challenging; not more challenging than for others in the NHS, but difficult nonetheless. Our strategy is to maintain our income and to improve profitability by cutting costs. It is that reduction in costs which provides scope for investment and

improvement. We need to save £25m in 2014/15 and a further £20m the year after that. We need to reduce our costs now – a start is to spend £1.5m less each month from 1 April. Our current plans do not achieve that. We will address that over the next few weeks. Safe care costs less. Safe care provides a better patient experience and outcome. Discipline in compliance with good care standards means less variation, less infections, fewer falls; patient’s stay in hospital is shorter and that saves money. Standardising the equipment and products we use releases time to care, reduces waste and saves money. Spending less is not about compromising on great care. How we do things is as important as what we do. This in turn builds confidence that we can do even more difficult things down the track. So delivering the savings we say we will in the way we said we will, matters. Discipline in managing within budget in every department, month on month matters. To help everyone to do their bit to improve care and through improved care to spend less we will be making information highly visible. That information will be very specific - public so we can all see how we can make a difference, and very visible – so we all know how we are doing. Securing our financial resilience will require hard work and difficult choices. We will all need to be prepared to do things differently - it is worth it. On that resilience we will invest to improve, become the best and SWBH be a great and fulfilling place to work.

Heartbeat - March 2014

Listening and Learning

Care Quality Commission (CQC) – helping us to provide great care The CQC has introduced a new approach to inspection. So far it is clearer how it will work for acute services than for our community teams. The CQC aims to inspect and rate all acute NHS hospital trusts in the new way by December 2015. Which Trusts are inspected first will reflect a variety of measures. Our Trust is presently considered low risk; rated at 5 out of 6 on the Intelligent Monitoring System issued every three months.

Site Visits Visits can be both announced and unannounced. Announced visits will include: • Patient and public listening events • Interviews: Chief Executive, Medical Director, Chief Nurse, Chief Operating Officer, Chair and Non-executive directors • Focus Groups: Doctors (consultants and trainees), nurses (registered and student, allied health professionals, admin and others) • Direct observations (e.g. wards, A&E, outpatients) Unannounced visits will usually be to follow up issues identified at the announced visit. Visits will take place in the daytime and at night. For acute services, the following “core services” will always be inspected (as they carry the highest risk): • A&E • Emergency Medical services, including frail elderly • Emergency Surgical services, including theatres • Critical Care • Maternity • Paediatrics • End of Life Care • Outpatients (selected) • Other services, if there are concerns (e.g. from complaints or from focus groups)

What we did at well at SWBH previously: •

Preparing and supporting staff for announced visits

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Carrying out regular mock inspections

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Reviewing processes and systems against the Essential Standards and making changes as required

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Greeting the visiting team positively and providing them with a base and resources to carry out their work and plenty of refreshments

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Responding to requests for information during the course of the visits

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Learning from the shortfalls in care identified by the CQC and responding rapidly to make improvements for their re-visits.

Where we want to do better: •

Involving all staff in the preparations

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For multi-disciplinary teams to have conversations about the CQC standards and their position against them and make changes where necessary

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Testing the application of the standards across the full range of services and patient groups

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Provide guidance and support on how to handle the inspectors

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Consistent messages to be given, particularly where practices are currently below the standard required

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Making sure we mention what we do well, as well as being open about weaknesses

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Having portfolios of evidence available and accessible to all – both to help staff prepare and so information is to hand if requested by the inspectors.

The CQC preparation plans include carrying out mock inspections across the Trust. These are likely to start in June, so watch-out for updates on this on the Staff Bulletin. Would you like to be one of our inspectors? Get in touch Kam Dhami if so. The CQC approach asks five big questions: 1. Is this service safe? 4. Is this service responsive? 2. Is this service caring? 5. Is this service well-led? 3. Is this service effective? What is your opinion? Do the people in your team agree? How would you answer the questions if a member of your family or a neighbour asked your advice? The CQC are important to assessing safety in our Trust. But we need to answer these questions even if the inspection is not until next year.

Patient Survey 2013 - Learning from our patients’ experience WHAT our patients tell us about the care and treatment they have with us is crucially important in shaping our learning about what we got right and what we could do better, Chief Nurse Colin Ovington writes. Our patient survey results this year tell us one major thing – that our efforts have not really changed our patient’s view of what we do. To be fair we do better than the national average on many questions in the survey, but on some we are worse than average. I hope you will join with me in not wanting to be in the mediocre bracket but to ensure that patients really are impressed by the efforts we make. We ratified our patient experience strategy at the Board meeting in February 2014 in an effort to bring the nine promises to life, if we get this right and go that extra mile it should make a difference to what patients say about their care and treatment. Our patients said: we need better communication. The clear messages that come through what patients say in the survey is that communication needs to improve. Talking over a patient and not involving them in discussions about their care and treatment are important measures; patients tell us that both doctors and nurses do this at a higher rate than elsewhere in the country. Many complainants tell us that communication is often a problem. A good place to start is by introducing yourself by name to every patient and visitor you meet (#hellomynameis) this is one of the pledges we signed up to as an organisation on NHS Change Day. Patients said: we need quieter wards. When patients were asked if they were bothered by noise at night we matched the national average. We have launched a quiet protocol in the Trust to give access to ear plugs and blindfolds, but also environmental noise is being managed with soft close bins to try and make a difference. Seventeen per cent of noise at night comes directly from staff, so we have our own behaviours to modify where we can while we are doing our job. Patients said: we need a better choice of food. Patients also told us that they

didn’t get as much choice of food compared to the results from other hospitals. This isn’t about what is on the menu, its more about what we do to give patients the choice of what is on the menu. None of us would go to a hotel and not expect to pick our own food off a menu, it’s simply isn’t good enough to just give new patients on our wards the food that is left. Only 52 per cent of patients said that they got help in eating their meal when it was required, lower than the national average. Ward staff should be very focused on this activity. Patients said: we are worried about being in pain. Pain control is one of the biggest things for our patients, it worries them that they will be in pain because of the treatments we give them or they have come to us because they have a pain which is a symptom of an illness. We were slightly worse than the average in managing pain, yet this is one of those things which is common in our patients. Responding to their concerns and giving pain relief on time has to be one of the clearest priorities we could all work on as a team. Patients said: we don’t want to wait so long for our discharge medicines. Finally when patients leave our care they tell us that they wait too long for medicines to take home with them at a rate which is higher than the average. In my extensive experience this is not usually a problem in pharmacy which is what most people would say, its more about anticipating that a patient will be going home and being prepared in the day or two before the day of discharge. iPads to increase patient feedback Patient feedback is a really important source of information for us yet only 18 per cent are asked to give any at the end of their stay with us. This year we are going to be relaunching the use of iPads to help collect patient feedback. This however is not the action that will make improvements for our patients; thinking more wisely about what we would expect for ourselves if we were the patient and behaving in a manner to achieve those expectations is what will make the difference.

Newsbeat

4 Heartbeat - March 2014

Working together to help patients

Surgery A

Showing our commitment THE 6cs winner for November, month of commitment, was Teresa Miller, staff Nurse on D25. Teresa was awarded the Commitment in Practice Award following nominations from a patient. The patient wrote: “Teresa’s only concern is the patient. “If you are in pain or have concerns she will make sure that they are addressed, from getting pain medication on time or raising concerns to the doctors. “Teresa is a true professional, ensuring that patients are cared for properly.” D6 Planned Admissions Unit was awarded the runners up certificate following a patient nomination which was full of praise for the whole team.

Understanding the 6Cs Care Makers, Staff Nurse Jade Howell and Health Care Assistant Kelly Hornby, who work on D25, developed a 6Cs board to raise awareness of the 6Cs among patients and staff. Jade and Kelly discussed the 6Cs with patients and found that they were not aware that the 6Cs represent nursing values, beliefs and underpin the care we deliver. They designed a simple questionnaire to ask patients, staff and visitors which 6C is important to them and why. They plan to collate the votes and display the results from the various groups involved.

(From left) Jade Howell – staff nurse (blue t-shirt), Kelly Hornby – Health Care Assistant, Pauline Mohan – Senior Sister and Sharon Reynolds – Ward Matron.

A NEW project is allowing trauma and orthopaedic patients to be discharged early following surgery, thanks to an idea put forward by Surgical Care Practitioner Derek Norman. Derek previously worked at the Royal Orthopaedic Hospital (ROH) where he had observed the good work done by the Royal Orthopaedic Community Scheme (ROCS) where patients are discharged early following surgery (continuing care is provided in their own home with professional support from the ROCs team). Derek was confident this model of care should be introduced at SWBH. The Orthopaedic service provides care at home for patients who have undergone total hip and total knee replacement surgery. Derek explained: “We started with knee patients and rolled the service out to hip patients one month later. “The average length of stay before the pilot was four and half days. “On this scheme the patients who are medically fit are discharged to their own homes on day two, with the support of the ROCS nurses and physios carrying out home visits. “To date we have had no readmissions or any surgical site infection concerns. “It all seems to be working very well. “Since the pilot we have reduced our cancellation of operations as we have a better patient flow and more bed capacity.”

(From left), Sherry Lea-Craig L3 Sister, Claire Hughes, ROCS Sister, Derek Norman, Surgical Care Practitioner T&O, Alison Hughes, T&O Matron, Ruth MacMullen Physiotherapist, and Evanda Pollock HCA.

Breast Unit team take the 15 Steps Challenge to see the service from a patient perspective THE team from SWBH’s breast unit is using an innovative tool to make improvements by viewing the service through a patient’s eyes. The Breast Unit team used the 15 Steps Challenge, developed by the NHS Institute for Innovation and Improvement, to assess the service’s base at the BTC. The challenge is based on the premise that patients’ impressions of NHS services are made within 15 steps of walking into the clinic or ward. It aims to identify what is working well and what could be better, highlighting what NHS staff may overlook, with a senior clinician working with other clinical staff and a patient. The challenge takes in all aspects of the patient journey, from car parking, the entrance and booking in to waiting areas, toilets and corridors. It is the first time that the 15 Steps Challenge has been used at the Trust and it is hoped that more services will now also take on the task. Martin Sintler, Consultant Breast and General Surgeon and Clinical Lead for

Breast Surgery, led the challenge in the unit. He said: “Patients, service users and their families and carers very quickly know whether they feel confident about the service they are visiting, and as clinicians we want to make sure that their experience is as good as possible. “After walking the patient path, we will now draw up a potential action plan to improve some of the things that the challenge has highlighted and then repeat at a later stage to see how the patient experience has been improved.”

SWBH staff taking part in the 15 Steps Challenge. From Left, Martin Sintler, Consultant Breast and General Surgeon and Clinical Lead for Breast Surgery, Sister Marion Mitchell, Karen Whitehouse, Senior Medical Secretary and Sue Frost, Macmillan Lead Breast Care Nurse.

Heartbeat - March 2014 4

Surgery B

Audiology team first among equals with national accreditation The culmination of many months of hard work has seen the Audiology Department at SWBH become only the seventh NHS trust in the country to gain a coveted national accreditation. The department has been formally granted accreditation against the Improving Quality In Physiological Service (IQIPS) Standard by the United Kingdom Accreditation Service (UKAS) - the sole national accreditation body to assess organisations that provide certification, testing, inspection and calibration services. The IQIPS programme aims to improve service quality, care and safety for patients undergoing physiological diagnostics and treatment. In order to meet the IQIPS standard, the Audiology team was involved in selfassessment and external peer assessment

against a set of 26 standards to assess accurately the level of performance in relation to established standards and to implement ways to continuously improve. The standards cover patient experience; safety; facilities, resource and workforce and clinical criteria. Dr Suki Dhillon, Consultant Clinical Scientist (Audiology) and Service Manager, said: “The whole department worked extremely hard to fulfil the IQIPS criteria, and we are delighted to gain the UKAS accreditation recognising this. “We are only the third trust in the region to gain the accreditation and the first local NHS organisation to achieve it for paediatrics. “We can now use the UKAS stamp, with its royal crown signifying government recognition, on our letterheads, leaflets, emails and web pages, bringing national recognition to the service and reassuring patients that they are receiving high quality services that are most appropriate for their needs.”

Sharing the learning from Never Events None of us want to be associated with a never event. As healthcare providers, our aim is to provide high standards of compassionate, evidence based, harm free care to our patients at all times. So when it goes wrong, and a Never Event occurs, we have failed to live up to this expectation. Here Brett Thornwell, BMEC Theatre Manager, tells Heartbeat what has been learnt from the Never Events in Ophthalmology. During the last two years the Birmingham & Midland Eye Centre (BMEC) has had five Never Events. The list comprises of three incorrect lens power implants, the retention of a metal plug following eye surgery, and an incorrect LASER procedure for a patients’ condition. Thankfully, in all five cases the patients’ outcomes were ultimately alright, however, that number of incidents has given serious cause for concern around the safety of our processes, and our consistency in following defined protocols and standard operating procedures. The very occurrence of these events has indicated where sufficient operational policies may not have been in place to prevent mistakes, or mitigate the risk of failures in the future. In addition untoward incidents have been a cause for us to look more widely at

all clinical processes, and question where or how another incident could occur. In spite of this good work and communication, it’s perhaps impossible to consider every possible permutation of every clinical event that takes place. In consideration of this, effective risk assessment skills within our teams is necessary. I was recently asked: “What are the most important lessons that I hope we have learnt from our Never Events?” This was not too difficult to answer considering the commonalities amongst them: 1. Do not deviate from the correct process, the agreed protocol or standard operating procedure. 2. Always positively identify our patients, and ensure that electronic records are correctly matched. 3. Feel empowered to call a “Hard Stop” to any clinical intervention if safety or quality becomes unduly compromised. 4. Only allow visitors to be present in clinical areas within a set of strict guidelines. In particular, company reps and product specialists who are often required to provide technical support, must be aware of our rules and etiquette. They must be supervised by a nominated supervisor, and their presence must have a genuine benefit to the patients or staff.

Newsbeat

Heartbeat - March 2014

Imaging

Inspiring change for more women in science

Annually on March 8, International Women’s Day is held to celebrate and promote women’s achievements worldwide. This year one of the themes is ‘inspiring change for more women in science’. Two of our female healthcare science professionals from Imaging shared what inspired them. Shazmeen Hansrod, Trainee Clinical Pharmaceutical Scientist, is taking part in a three-year scientist training programme accompanied by an MSc in Clinical Pharmaceutical Science that she is completing at the University of Manchester. Whilst working at the Trust Shazmeen has been inspired by her training officer Associate

Director of Healthcare Science, Jilly Croasdale. Shazmeen said: “She has achieved a great deal in her career and continues to do so. “She has always taken opportunities to progress in her field and her proactive nature has seen her become a very successful woman. “Despite her extensive knowledge and experience, she still manages to remain grounded. “I feel inspired to take a leaf out of her book and maybe one day achieve as much as she has.” Jilly Croasdale, Head of Radiopharmacy and Associate Director of Healthcare Science, always enjoyed science at school, and went on to do a vocational degree in Pharmacy. Following graduation Jilly was offered a job

in Radiopharmacy, a career which she finds interesting and rewarding - particularly the opportunity she had at the Royal Free Hospital in London to work with Cancer Research UK, helping to develop new methods for targeting cancer therapy. Jilly, a mum of two herself, said: “My mum was a working mother and always encouraged me. “Career wise, I have been inspired by many people over the years, in particular, Jackie Morton, who was previously the Divisional Manager for Imaging and had a background in Pathology. “She was a real role model, and encouraged me to think I could do more.”

Now as Head of Radiopharmacy, Jilly enjoys the blend of managerial and practical tasks. She said: “I enjoy developing my service and my staff, and seeing what we can achieve as a team. “I get so much job satisfaction, it’s worth the effort.”

Jilly Croasdale and Shazmeen Hansrod.

Showcasing bright ideas at the Healthcare Science Innovations Day STAFF were invited to come along to the Trust’s second annual Healthcare Science Innovations Day to see some of the astonishing innovative improvements in patient care that are taking place in the Trust by Healthcare Scientists. Jilly Croasdale, Associate Director Healthcare Science, opened the event, she said: “Making time for innovation is important; not only does it improve the care we give to our patients, it is good for business. “Hospitals who innovate not only attract patients as they will be able to offer a wider portfolio of services; they are also more attractive as a place to work.

Pathology

Microbiology certificate success

Medical Laboratory Assistants (MLA) within Microbiology are continuing to pioneer the new learning pathways offered by the Institute of Biomedical Science. Pav Jheeta, who was the first MLA in the UK to be awarded the Institute’s Part I Certificate of Achievement, has now become the first to gain a Part II. Pav has also been invited to join the Institute’s local committee. Meanwhile, Brenda Blundell, Sue Fletcher, Sharon Gillies and Emma Preston, and have also gained the Part I Certificate.

Sharon Gillies and Sue Fletcher with their IBMS Certificate of Achievement.

“That's the type of organisation I'm proud to say I work for.” Among those attending were Joseph O'Brien, Clinical Scientist (Nuclear Medicine) who gave a presentation on the clinical impact of SPECT-CT . Joseph said: “After its introduction last year, the equipment has made a significant improvement in sensitivity and specificity in relation to bone scans and parathyroid adenomas. “Ultimately, patients receive a more accurate diagnosis far sooner than before, which speeds up their treatment process.” Andy Hayling, Deputy Group General Manager for Pathology, gave a presentation

New technology in Microbiology THE SWBH Microbiology Department at City are carrying out a trial into the rapid detection of enteric pathogens including Salmonella, Shigella, Campylobacter and E.coli, using a new state-of-the-art method. The EntericBio PCR from Serosep utilises the latest gene-probe technology to speed up elimination or detection of harmful bacteria from the current 48 to 72 hours, to less than 24 hours. The method also reduces materials and waste. If the trial proves successful, and early indications are that it will, then the method will be introduced into the mainstream laboratory by late spring.

Microbiology staff and Serosep technicians set up the EntericBio equipment in the laboratory.

about a current project around the concept of using big data for a risk stratification model in sepsis. Sepsis is a major cause of mortality and morbidity worldwide. Andy said: “Many of our patients undergo many tests and procedures during their diagnosis and treatment. “Each patient will have an accumulation of many data items stored on various systems across the Trust. “It is estimated that pathology alone stores over 21 million tests per year. “The amount of Trust wide data item storage puts it into the big data league. “The aim of this project is to ascertain

whether using big data concepts we can provide innovative forms of information processing for enhancing insight and medical decision making. “Hopefully the end product will help early intervention of sepsis and associated improvement in patient outcome.”

Jilly Croasdale and Roger Stedman present some of the Healthcare Science Innovators

New Blood Science Laboratory opens ALMOST £3 million has been invested in creating a new Blood Sciences Laboratory at Sandwell Hospital to help speed-up the diagnosis of patients. The laboratory, which uses state-of-theart equipment to analyse samples quickly and accurately, was officially opened on 22 January by leading pathologist and author Dr David Burnett. The former microbiology and histopathology laboratories have been refurbished into a large open plan space where new modern robotic analysers, equipment and conveyor tracks have now been installed, helping to cope with increasing demand by reducing the cost of testing and minimising errors. More than 7,000 samples a day are processed, producing around 30,000 test results. The facility offers a seven day a week, 24 hour service with staff testing samples from the Trust’s inpatients and outpatients as well work from GPs, helping in the diagnosis of everything from cancers, to HIV and vitamin deficiencies. This is the first of two phases of reconfiguration of the laboratories designed to fit with the needs of the proposed new Midland Metropolitan Hospital, which will see microbiology, specialist laboratories and eventually the histopathology laboratories also

being transferred to the Sandwell site. At the opening Toby Lewis, Chief Executive, said: “We are investing in one of our strengths with the opening of the new Blood Sciences Laboratory. “Local GPs know the value of the high quality, quick turnaround service offered by our teams. “As we look to integrate care in Sandwell and in West Birmingham, diagnostic services have to be at the forefront.”

Dr David Burnett discusses his new book on quality with Sandwell Hospital Laboratory staff (From left) Julie Evans (Pathology Quality Manager) Pervaz Mohammed (Principal Biochemist) Nicola Barlow (Principal Biochemist) Deon Coley-Grant (visiting Principal Biochemist) at the opening.

Newsbeat

6 Heartbeat - March 2014

Medicine & Emergency care Putting chest patients on the right path A NEW chest pain pathway has been launched within the Emergency Departments to help improve patient care. The pathway has been developed to help teams to do the correct tests and to decide where to send patients with particular chest pain symptoms. Dr Shaun Nakash, Clinical Director of Emergency Medicine, said: “We are hoping that this pathway will help improve the patient journey, also it will focus us on providing high quality care and ensure we reduce the chance of harm coming to patients.” The pathway has been in development for some time, with cardiology, acute medicine and emergency medicine working in collaboration with the Emergency Departments. Dr Doug Robertson, Consultant Diabetologist and Acute Physician, said: “Our aim is to rule out heart pain quickly for the majority and let them go home, but at the same time identify the people who really need to see a cardiologist and have further tests. Dr Chetan Varma, Consultant Cardiologist, said: “'Coronary disease is highly prevalent in the area we serve. We have a reputation for always being amongst one of the first Trusts in the country to offer world class therapies for heart attack patients and these are just a small number of all the patients seen with chest pain.” Dr Nakash added: “We are open to any feedback that staff have after using the pathway as we look to improve it further.” Any feedback can be sent to Anne Townsend, Senior Transformation Manager, on annetownsend@ nhs.net.

Nurses visit from Hong Kong SANDWELL Hospital welcomed two nurses from Hong Kong to view the facilities and to share learning points. Henry Poon and Suk Fong Wai, both Advanced Practice Nurses, came to Sandwell to spend the day with Anne Lowe, Lead Respiratory Clinical Nurse Specialist. The nurses were in the UK for a month, along with six other nurses from Hong Kong, organised by Education for Health to learn about chronic respiratory disease and how it is managed in the UK compared to Hong Kong. The nurses had a busy month full of training sessions and visits to Specialist Respiratory Nurses both in the hospital and community to see how we diagnose and manage patients with chronic respiratory conditions such as asthma, COPD, Bronchiectasis and pulmonary fibrosis. Anne said: “I was very proud to be asked to host the nurses and to show them what an excellent respiratory service we have here in Sandwell, both in the acute hospital and in the community. “It was also very interesting for me to learn how they work in Hong Kong. “Both nurses work in hospital

respiratory units. “I was able to gain insight from Henry of how they operate their inpatient sleep assessment service for people with obstructive sleep apnoea who are being considered for nocturnal ventilation, something which we do not do in hospital at the present time.” During their visit to Sandwell they were able to learn about the role of the Respiratory Specialist Nurse in the hospital and how patients are managed when admitted acutely unwell through to discharge to the community respiratory team. They also saw patients who were taking part in the pulmonary rehabilitation programme.

(From left) Anne Lowe, Lead Respiratory Nurse Manager, Poon Henry, Advanced Practice Nurse, Wai Winnie, Advanced Practice Nurse, Sarah Bearne, Respiratory Specialist Nurse.

Heartbeat - March 2014 6

Cardiology offers patients the direct route THE Trust is now offering a new service to GPs that will help patients get access to cardiology investigations more efficiently. Direct access to cardiology diagnostics is letting GPs send patients directly to the department where cardiac physiologists and cardiographers carry out a variety of cardiology tests and results, rather than having to go through a consultant as was done previously. Katy Thorpe, Directorate General Manager, said: “We hope this will make a more efficient service for GPs and it will also be a quicker turnaround for patients who will be getting what they need from us the first time round, without needing multiple visits.” The service, which launched on 6 January, is the only service of this type in the West Midlands and received 54 requests within its first two weeks, and has reached around 170 requests in total. Louise Tyler, Cardiology Diagnostics Manager, said: “I think this significantly improves the service to these patients, by reducing the time it takes for them to have a test and get the result. “We aim to get all patients in to see us within three weeks, although the demand has been so high, we have to look into getting extra resources which supports the service even more.” Katy commented: “This service is being offered through a lot of hard work by our cardiac physiologists and we would like to thank them for their effort.” Louise added: “I would also like to thank all of our team - the clerical staff for all the administration side, and our team of technical staff - cardiographers and cardiac physiologists, all of whom have willingly taken on board this service improvement with the knowledge they are helping to increase the quality of the patient’s experiences.”

Lights, camera, action in the Serenity ‘Big Mother’ chair

Women’s & Child Health

Paediatric bake off reaps rewards STAFF from Sandwell Paediatrics recently got baking, and eating, in aid of new equipment for the play team. The result was £55, which was spent on activity books and Easter craft activities. The winner of the Great Sandwell Bake Off was Dr Maria Atkinson, whose prize-winning carrot cake won her cookery book and the prestigious ‘Best Baker’ title.

NEW mothers will have an opportunity to record their experiences thanks to a new video diary room set up at City Hospital’s award-winning Serenity Suite. The private diary room will welcome new mothers to record their experiences on birthing at the midwife-led care facility. As ‘Serenity ambassadors’ their messages will be shared via the Trust website (www.swbh.nhs.uk) with other expectant mothers who are planning

their own delivery at the Serenity Suite, helping reduce anxieties and assure them they are in safe hands. Clinical Director for Maternity and Perinatal Medicine, Elaine Newell said: “We pride ourselves in providing the very best experience for expecting mothers and are always seeking ways to improve this. “The Big Mother Chair will literally put mothers in the centre seat to help drive changes and shape our priorities.” A mum and baby in the 'chair'

New technology in Maternity Services to steer mums through the pregnancy pathway

(From left) Jo Bryer, Project Midwife, Sally Bryan, Assistant Operations Manager and Ayesha Bauld, Community Midwife.

AN innovative project due to go live in Maternity Services on 1 April will use new systems and technologies to support the whole pregnancy pathway. The current eVolution maternity system will be replaced with BadgerNet, a maternity application which supports women from their first contact in antenatal care through to delivery and postnatal care. The system will not only capture electronic data, but also replace the existing paper hand-held and intra-partum records, acting as an inclusive electronic patient record. Once fully implemented, the BadgerNet system will support the clinical and operational requirements of Maternity

Services and remove the risk associated with the use of the current paper-based systems. The project also embraces new technology. Community midwives will each have their own iPad on which to capture clinical data and document patient records, in real time, closer to home. Hospital staff will have access to laptops or desktops on which to record clinical data. Sally Bryan, Assistant Operational Manager in Maternity Services, said: “The maternity record within the BadgerNet Service will cover all activity and data collection during the entire pregnancy journey, from booking through to delivery and postnatal discharge.

“This is a really exciting time for Maternity Services, with the community midwives receiving their iPads in the near future. “Further training is still being planned and delivered, with testing of new ways of working and the associated technology ongoing.” Over the next few weeks, information and flyers will be distributed around clinical and non-clinical areas, demonstration dates will be released and staff will be encouraged to take part in training as required. For more information, contact Sally Bryan on 07964 379105 or Jo Bryer, BadgerNet Project Midwife, on 07766 466785.

Community and Therapies

Heartbeat - March 2014

Speech and Language Therapists help Bob to find his voice again A CHARITY donation is helping Birmingham patients who have lost their voice box following cancer treatment to talk to friends and family again. A number of patients each year have surgery to remove their larynx (voice box) as a result of head and neck cancers. For Birmingham patients, this surgery is done at the Queen Elizabeth Hospital but patients return to City Hospital for all their post-operative care. One such patient was Bob Mason, who underwent a laryngectomy operation in 2007 to remove his larynx. After the operation, many patients are fitted with a silicone valve to help speech, but unfortunately Robert was not able to go through this procedure. Communication became extremely difficult and his only options were mouthing and writing, which was frustrating for him and his family. Bob wasn’t the only patient unable to go through the procedure, so the Speech and Language Therapy Department applied to the Get A-Head Charitable Trust for funding to purchase a set of electrolarynxes.

These are devices used to produce electronic speech for those patients who have lost their voice boxes. The devices are expensive but an award of £2,150 was donated, enabling the Speech and Language Therapy Department to buy five new electrolarynxes. Bob - who used to work in the post room at City Hospital and for many years delivered mail to the very department which later treated him - was the first person to benefit. Using his electrolarynx, Bob said: “It’s given me a whole new perspective on life. “I used to have to write things down, but now I can talk and even use the telephone.”

From left, Mandy Mason, Bob Mason with his electrolarynx and Rowena Yeates, Senior Speech and Language Therapist

Community DVT screening pathway goes live DEEP Vein Thrombosis has been identified as the third most common cardiovascular condition following acute coronary syndrome and stroke. It is a potentially serious condition and patients have previously been assessed and managed in Sandwell and City Hospitals, which resulted in increased A&E attendance. In line with the need to reduce cost and reduce demand for admissions to secondary care, the SWBCCG has commissioned the new community DVT screening service to give patients with suspected DVT the choice of care in their own

home environment and minimise unnecessary hospital admissions. The service went live in November last year. Referrals are received directly from the GPs by ringing ICARES on a single point of contact. Patients are then contacted and triaged and the response time is within two to four hours. If they have other long term conditions, that will also be addressed at the same time. This is an integrated service working hand in hand with the GPs, Pathology lab, the radiology department and patient transport to ensure seamless care and service is delivered.

SWBH team shares end of life skills with nursing homes staff A STUDY day on 12 February enabled the SWBH Specialist Palliative Care Team to share their skills and expertise with staff from local care homes. The End of Life Skills event, held at the new Portway Lifestyle Centre in Oldbury, brought together around 60 care home managers and nursing staff. The event, which was supported by the West Midlands Care Association, allowed the attendees to explore the key points around palliative care, including identifying the dying person, difficult conversations, advance care planning and symptom control at end of life. Sue Law, Bereavement/SCP Practice

Development Nurse at SWBH, said: “We decided to hold the event to help our colleagues across the care home sector to learn more about end of life and guiding them through the journey from start to finish, making the process as smooth and compassionate as possible.” One of the attendees, Emma Bodycote, who works as a Care Homes Quality Professional Adviser at SWB CCG, said: “Death and dying is a challenging topic, which all care home workers will face at some point in their careers. “This study day has helped to overcome the fears around the situation and encourage care home staff to use all the support available to them, whether that is their colleagues, GPs or the palliative care team.”

SWBH UP YOUR STREET

Fact File: •

•

Anticoagulant Services is part of Haematology and is responsible for the anticoagulation monitoring for over 6,000 patients across the Sutton Coldfield, Sandwell and West Birmingham area. It’s a small multidisciplinary team made up of biomedical scientists, nurses, clinical support and administrative staff which undertakes 30 clinics, 3,000 appointments and 200 home visits per week co-ordinated from its office base at City Hospital. Whilst the staff are in secondary care, the service is unique in that it delivers the majority of its clinics in the local community, operating from local health centres and GP practices. The service is a one stop clinic where the patient has their blood tested, discusses their new warfarin dose and receives the date of their next appointment at a location closer to home (or work place), thereby eliminating costly and sometimes lengthy trips to outpatient departments. For those patients with mobility issues, the service provides home visits when a member of staff visits the patient to obtain a blood sample which is then transported

back to Haematology for testing and dosing. •

Frequent monitoring, especially for those who work, can be problematic.

•

The service has therefore expanded to deliver the growing demand for patient self-testing.

•

With the government encouraging patients to be more involved in their health care, particularly in managing long term conditions, there has been a steady increase in the number of patients who have purchased their own warfarin monitors.

•

The anticoagulant service assists with training patients to use the monitors, which gives patients the convenience of testing at home and the reassurance of access to the same high quality care from the hospital team that they are familiar with.

•

The service provides a dedicated telephone line for advice and appointments.

•

Referrals received directly to the service or through choose and book are triaged within 24 hours.

•

Patients are seen within two weeks of receipt of referral.

How anticoagulants help our patients Anticoagulants are a group of medicines that stop blood from clotting. They are most commonly prescribed for people who have had a condition caused by a blood clot or are at risk of developing one. These conditions include: • deep vein thrombosis (blood clots in the veins of the legs) • pulmonary embolism (a blood clot in the lungs) • atrial fibrillation (a heart condition that causes an irregular heart rate) • mechanical heart valve. Atrial fibrillation (AF) is the most common reason for prescribing anticoagulants. The way the heart beats in AF means that there is a risk of blood clots forming in the heart chambers. If these get into the bloodstream, they can cause a stroke. Warfarin is the main oral anticoagulant used in the UK.

Over anticoagulation may lead to bleeding, whilst under anticoagulation increases the risk of patients having a blood clot. Warfarin interacts with many other medications, some foods and alcohol. Taking warfarin, therefore, requires regular attendance at an anticoagulation clinic to monitor and adjust treatment dose. With more than 2.5 million people in the UK prescribed the anticoagulant warfarin, it’s no wonder the team at SWBH is a busy department. Rixaroxaban, dabigatran and apixaban are newer anticoagulants that may be used as an alternative to warfarin for certain conditions. These newer anticoagulants require less monitoring than warfarin and have less interactions with food and other medications but require the same cautious approach to prescribing as other anticoagulants. It’s therefore essential that this group of patients receive adequate education about their condition and treatment.

Members of the Anticoagulant Services

Listening to and acting on

Encouraging signs in early results, but a long way to go! THERE is a growing body of evidence which shows the strong link between high levels of staff engagement and better patient care. In September the Trust launched Your Voice, a short monthly online staff survey. It’s our way of hearing how colleagues are feeling, sharing their ideas for improving services for patients and measuring our levels of engagement.

did the survey in September. What was really encouraging about these results is that where groups and teams had responded to the issues raised by staff, they saw significant improvements in their staff engagement scores. This shows that by responding positively to what colleagues are saying we can make a real difference to how they feel about their work quite quickly.

It’s ambitious in scale, every month a third of the Trust, around 2,500 people, are sent the survey via their NHS Mail accounts.

But Your Voice is about more than the quick fixes.

League tables of results by group, directorate and team are published on the Your Voice page on Connect.

In 2014-15 what you say about your services will be part of how your service is appraised and how managers are appraised.

Last month we had the second set of results from the first four clinical groups which

Your Voice – League Table by Directorates - Top Ten Directorate

Response Rate

Disengaged

Neutral

Engaged

Your Voice - League Table by Directorates - Bottom Ten Overall score

Ranking

Directorate

Response Rate

Disengaged

Neutral

Engaged

Overall score

Ranking

Immunology

53%

31%

68%

3.92

Biochemistry

34%

41%

50%

3.56

=20

Nuclear Medicine

57%

20%

71%

3.91

Histopathology

32%

16%

29%

56%

3.56

=20

27%

67%

3.86

Operations

22%

40%

52%

3.56

=20

Paediatrics

18%

24%

72%

3.85

Scheduled/Long term conditions

12%

34%

54%

3.55

Diagnostic Radiology

14%

25%

70%

3.83

Finance

27%

42%

49%

3.51

Community Children

16%

25%

67%

3.80

Gynaecology, Gynae-Oncology & GUM

18%

47%

48%

3.50

=25

Directorate C, Theatres, Urology & Vascular Surgery

27%

66%

3.76

Workforce

51%

14%

34%

52%

3.50

=25

Admitted Care

23%

70%

3.75

Medical Director's office

36%

12%

38%

51%

3.47

18%

30%

61%

3.75

Directorate D, Anaesthetics & Critical Care

17%

12%

43%

45%

3.44

31%

61%

3.71

Haematology

36%

12%

46%

42%

3.38

Maternity & Perinatal Medicine

Community & Therapies Emergency Care & Acute Medicine

Positive response brings improved scores THE team which achieved the highest level of awareness of changes made as a result of the Your Voice survey in January was Hearing Services. They also achieved a big improvement in their overall staff engagement score, moving up from 26th place to 15th in the latest league table (which can be found on the Your Voice page on Connect). Service Manager Dr Suki Dhillon made an action plan based on what staff said in the survey and communicated the outcomes via email and team meetings. “We looked at the overall results and they were a bit disappointing, but we took it as a positive as staff had taken the time to express their

views,” she said. “We decided this is where we are now, but we have the information to enable us to take action and improve. “We were aware of most of the issues raised by staff, but we didn’t realise how much they were impacting on the team. “The survey results focussed the mind and made you take stock.” The extra focus meant issues raised were acted on more quickly as they were given a higher priority. For example, staff asked for more appropriate use of individual staff skills when arranging the staff rota and for the rota to be available at least five weeks in advance, which is now in place.

(From left): Charan Vasudeva, Mark Hassall, Sue Evans, Joanne Lodge, Rafiqua Adalat, Shamila Munir, Suki Dhillon, Emma Moulds, Stacy Morrow, Jennifer Parker, Prem Verma, Andrew Challis, Emily Halliwell, Rasheda Begum, Sarah Barnes and Sharon Thomas.

What you can learn from Learning and Development FOR the first three months of the Trust’s new Your Voice survey, the team which scored best was Learning and Development (L&D). Jim Pollitt, the Head of L&D, said he thought the main reason his team felt more engaged than others was because all had an effective PDR and were being developed in some way. This development is not attending courses and gathering certificates, although some of that is needed, but about broadening their roles, giving status and responsibility, allowing

the team to explore new ways of doing things and not blaming them if things go wrong. Managers at every level have regular 1-1s, sub-team meetings are held monthly and every six weeks or so there is a full L&D team meeting. Guest speakers are invited to give their view on things and the time is also used to run development workshops to gain ideas and suggestions for service improvements. All of the team is up to date with PDRs and mandatory training. Most of the team have attended

Action Centred Leadership training and understand what their role is and where this fits within the whole service. Jim said: “We have low sickness absence levels. “We offer opportunities such as secondments, apprenticeships and continued development. “As a result our staff turnover is very low. “In effect, we practice what we preach.” If your team would like help with any of these areas, please contact L&D.

Improved communication is making a difference THE team which had the single biggest improvement in its engagement score between the first survey in September and the latest one in January was Medical Secretaries in Surgery A. First time around, their score was the lowest in the Trust, but a big improvement in January has seen them jump out of the bottom 10 teams. That improvement was matched by the Surgery A group as a whole, which put together an extensive action plan to improve communication following its low score in September. Yvette James was asked to temporarily manage the Medical

Secretaries following the Your Voice results, and set up regular meetings with the team leaders, which made an immediate difference. “Sharing ideas and solving problems together has enabled me to share with the team leaders things the group is doing and for me to benefit from their knowledge and understanding too,” she said. In February Medical Secretaries got together off site for a Listening into Action event where they were asked for their suggestions to improve their service. At the end they were invited to vote for their top five. The result was: 1. Improved communication. 2. Monthly team meetings and

regular engagement events cross site. 3. Achieving the 48 hour target for letter turnaround through forward planning and sickness / leave cover. 4. Improved IT systems. 5. Better cross-site working and paperless GP letters.

Medical Secretary Jayne Hipkiss votes for her top priorities for action at the end of February’s Listening into Action event.

what you have to say!

THREE OUT OF FOUR STAFF BELIEVE CARE IS NOW OUR TOP PRIORITY We have our monthly Your Voice survey, but each year a sample of people who work here are selected nationally to contribute to the NHS-wide survey. Thirty seven per cent of our sampled staff responded. Here is what they said: Seventy five per cent agreed or strongly agreed that the Care of Patients is our Trust’s Top Priority – 10 per cent more than in the 2012 survey – showing a strengthened confidence in our determination to provide the safest and highest quality of care and services to our communities.

Now we need to understand: •

What persuaded 75 per cent that we are indeed focused first on care and safety?

•

What worried 25 per cent of colleagues or what did they think the Trust values more highly?

How will we respond to what you said in the 2013 staff survey?

Our overall scores 2012

2013

Trend

STAFF ENGAGEMENT SCORE 3.67

3.73

3.81

3.79

We will continue to make sure that the interests and safety of our patients and service users is at the centre of everything we do and that our Trust is a place where everyone wants to work. To be successful on this journey, we will be having an even greater focus on:

STAFF MOTIVATION SCORE

SATISFIED AT WORK SCORE 3.62

3.55

The majority of the 28 key findings showed little or no change since our 2012 survey, the most significant changes are. 2012

2013

Growing our culture of safety and openness – through sharing quality and safety concerns with our Chief Executive and senior teams at monthly ‘hottopics’ briefings. Making sure staff know how to raise concerns and feel safe and comfortable to do so. Following our Patient Safety Summit last month, we are testing our Trust’s safety culture down to team level. We will introduce a new whistleblowing policy and publish our risk registers for the whole organisation on Connect.

Trend

I WOULD RECOMMEND MY PLACE OF WORK TO FRIENDS AND FAMILY FOR PATIENT CARE OR A JOB 3.71

3.52

I AM SATISFIED WITH THE QUALITY OF WORK AND PATIENT CARE I AM ABLE TO DELIVER 84%

77% 0%

100%

Living our values – through making sure that demonstrating behaviours in line with our values is seen as of equal importance to ‘getting the job done’. Our rule of thumb is that we treat our colleagues and our service users as we would want our nearest and dearest to be treated.

100%

COMMUNICATION IS GOOD BETWEEN SENIOR MANAGEMENT AND STAFF 32%

38%

100%

STAFF EXPERIENCING POTENTIALLY HARMFUL ERRORS, NEAR MISSES OR INCIDENTS 34%

26%

100%

Listening to our staff and acting on their feedback in equal measure to patient feedback - through our ‘real time’ monthly staff polling ‘Your Voice’ that gives us staff feedback down to team level in the organisation. We are focusing on increasing access to IT to enable staff that don’t routinely access PCs in their day-to-day work a better chance of participating.

STAFF EXPERIENCING HARASSMENT, BULLYING OR ABUSE FROM PATIENTS 30%

19%

100%

You can see the full set of NHS Staff Survey results on Connect.

So what did we do in response to the staff survey in 2012 and what difference has it made? We said we would

We did

Change in 2013

Introduce local staff polling to gain ‘real time’ staff feed back to help to improve our levels of staff engagement.

We introduced ‘Your Voice’ in September 2013 and you can read more about this across these pages.

Increase in staff engagement from 3.67 to 3.73

Ensure that all staff have an annual appraisal.

Every member of staff has an annual appraisal by 31 March 2013 and those that haven’t will be contacted personally.

A similar number of staff saying that they’ve had their appraisal and a slight improvement in staff saying they had a quality appraisal.

In the majority of cases this involved patients suffering from a lack of capacity. We engaged with the Trust’s Dementia lead to ensure that staff awareness about the needs of this client group is heightened.

Our results show an improved position with 3 per cent less staff reporting experiencing violence from patients.

Take action to protect our staff from physical violence from patients.

Investing in our leaders – through this month’s launch of our 18 month leadership development programme to reflect our existing leadership model (Action Centred Leadership) in supporting the top 150 leaders in Trust to undertake their leadership role outstandingly.

Dealing with violence In 2012 as in 2013 we still see in our results an indication of physical violence from patients but more disturbingly some reported that they had experienced physical violence from STAFF over the past 12 months. We said it then and again now that this type of behaviour will not be tolerated. Our Trust Convenor, Chris Rickards, said: “All workers have a right to be treated with dignity and respect at work and any kind of violence or bullying denies this right. “If you suffer from any form of violence you must report it immediately, otherwise the Trust cannot take action to support you and deal with this totally unacceptable behaviour. “If you are unable to report it to your line manager, you should contact an alternative manager, a trade union representative, a member of the human resources team or maybe a colleague to raise this on your behalf.”

Trusting your own family’s care to SWBH - would you?

Senior Transformation Manager Anne Townsend was more than happy for her mum Janet McKnight to come under the care of SWBH as she recovered after suffering a stroke. As part of her recovery Janet was visited by ICARES Rehabilitation Support Worker Lisa South in her home in Great Barr. In fact the family was so pleased with the care given by Lisa that Janet took the opportunity to nominate Lisa for the Excellence in Customer Care Award at the SWBH Staff Awards last year that Lisa went on to win. The question of whether you would entrust your own family’s care into the hands of this

organisation is a question respondents were asked to answer as part of this year’s staff survey (fifty nine per cent said they would, which was a rise on last year, and nine per cent said they would not). Anne explained why she was so pleased with her mum’s care in the hands of SWBH staff. She said: “Having a stroke is certainly one of life’s cruellest blows and renders the strongest of family units quite powerless. “We all expect the medical needs of our loved ones to be met as a minimum standard but it is often the small kindnesses and considerations to patients that can make all the difference to a patient’s recovery.

“This was certainly the case for my mum and these are just a few of the examples: • The pharmacist who took the time to reassure mum about her medication • The HCA who made mum laugh and lifted her spirits whenever she was on duty • The therapist who clearly explained and taught us how to handle my mum safely • The nurse who carefully explained what was involved in planning a Package Of Care • The transport crew who understood her anxiety on her journey home.”

Janet McKnight and daughter Anne Townsend, Senior Transformation Manager.

Corporate and General News

Pay Dates 2014/2015 Month

Pay Date

April

25th April 2014

May

28th May 2014

June

27th June 2014

July

28th July 2014

August

27th August 2014

September

26th September 2014

October

28th October 2014

November

27th November 2014

December

22nd December 2014

January

27th January 2015

February

27th February 2015

March

27th March 2015

How you can help the environment Staff are being urged to ‘think green’ and do their bit to help in reducing the Trust’s impact on the environment. Fran Silcocks, Sustainability Officer, said: “We recognise that becoming more environmentally sustainable will reduce our carbon footprint, reduce costs, and improve health. “We really need staff to help us towards our Trust environmental sustainability objectives by taking these simple steps: 1. Become a Trust Sustainability Champion - We need managers to nominate one ‘Sustainability Champion’ from their area. 2. ‘Turn it off ’ - Switch off lights in unoccupied areas, turn off PC monitors during breaks and at the end of the day. 3. Turn down radiators when not needed and ensure doors and windows are closed when the heating is on. Report overheating issues to Estates (ext. 4444). 4. Water use - Turn off taps and report drips and leaks. Only use the right amount of water when filling the kettle or washing up. 5. Waste less and recycle more - Follow the Trust’s waste policy for segregation of clinical and non clinical waste. 6. Getting to work - Travel by bike, foot or public transport wherever possible. 7. Printers and photocopiers - Do not print unless it is essential. In this case, print doubled sided and/or use scrap paper.

Ward services raise a grand

WARD Services at City Hospital ran a fun day which raised over £1,000 for the Trust Charity. The event, held in December, involved stalls selling books, Indian clothes, cakes and samosas as well as having a live band. The money raised will go towards the Cardiology Department. Doreen Boyce, Ward Services Manager, said: “We decided to raise money for Cardiology because some of our staff and their families have had heart attacks and had stents fitted.” This is the second year the day has been held.

Staff from Ward Services at City Hospital.

Last year they raised around £600 for Cancer Research, and plans have already started for this year’s event. Pat Frowen, Ward Services Manager, said: “We would like to thank all of our staff for their hard work and help. “Without their support the event wouldn’t have gone ahead.” Doreen said: “All the staff helped out on a really happy day and it was a fantastic way to bring everyone together.” If you want to raise money for the Trust Charity, contact the Fundraising Department on Ext: 5196 and swbh.fundraising@nhs.net

Heartbeat - March 2014

Supporting staff with sickness absence Managing employee health and well-being is critical to the smooth running of the Trust and involves line managers seeking advice from Occupational Health and Human Resources to proactively manage cases as well as individual employees taking responsibility for their health. Employees are supported in taking personal responsibility for their own health and wellbeing and prevention of ill-health with incentives for healthy lifestyle choices. To support employees a range of health and wellbeing initiatives have been introduced and implemented within the Trust. Line managers can identify at an early stage if an employee is struggling at work and address this in a supportive way with the employee. We have spoken to managers who have been successful in managing sickness who are keen to share their learning points. Margaret Bradley, Ward Manager M1/M2, City, said: “My tips would be to ensure all conversations and

correspondence are documented, print off e-mails and separate within the member of staff personal file all their sickness records in year order.” Patricia Frowen, Ward Services Manager, City, said: “I feel that supporting staff in their return to work is a high priority, utilising the various measures in line with the sickness policy for example, reasonable adjustment checklist, planned rehabilitation programmes and stress risk assessments. I must admit, to reduce percentages in sickness absence does not come easy, hard work, commitment and thinking out of the box at times does enable you to get results.” Petrina Marsh, Clinical Lead Children’s Therapies, said: “When staff have been unfortunate to require several weeks off work, negotiating a phased return has helped them return sooner. Return has been phased in terms of time and duties. Again the supportive culture within the team has helped, with staff giving lifts to and from work when a member of staff broke her arm.” For more information on managing sickness log on to the Human Resources pages of Connect.

Tips for managing sickness absence 1. Ensure managers and supervisors understand the Sickness Policy and have attended sickness absence training. 2. Communicate departmental absence levels monthly and ensure employees comply with local absence reporting procedure. 3. Foster a positive work environment and develop mechanisms for engaging employees. 4. Ensure Return to work interviews are held for all episodes of sickness absence, and are used to address concerns through two –way discussion. 5. Monitor all sickness absence records and arrange timely review meetings for employees who hit a Trust trigger. 6. Carry out departmental risk assessments and seek advice from Occupational Health if there are patterns of absence arising. 7. Agree support / contact arrangements with employees on long term absence to ensure they don’t feel isolated

and understand how their case will be managed. 8. Immediately refer employees absent as a result of musculoskeletal or psychological causes to Occupational Health as well as cases with no anticipated return to work date within 4 weeks. All cases should be referred by 28 days’ absence. 9. Discuss the advice from Occupational Health with the employee and jointly identify measures that could assist the employee to return to work utilising tools such as the Reasonable Adjustment Checklist / Stress Risk Assessment as appropriate. 10. Review the case management action plan for long term cases on a monthly basis with HR to either arrange a return to work within a reasonable timescale or hold a review meeting with the employee to discuss other options and implications on employment .

Tracy is a Flu Fighter Champion Tracy Lees, Occupational Health Nurse Manager, has won a national award for helping to gain extra funding by increasing the number of staff vaccinated. Tracy won the ‘Flu Fighter Champion’ prize at the Flu Fighter Awards, run by NHS Employers. She has managed to help get 77 per cent of patient facing staff vaccinated against the flu, which beats the government target of 75 per cent allowing the Trust to be allocated part of a national £250 million grant to help services across the Trust. This figure makes the Trust the highest performing adult trust in the region. Tracy said: “I was overwhelmed to receive the NHS Flu Fighter Flu Champion award, especially after being up against such strong competitors. “It is wonderful to receive national recognition for all the hard work which goes into the flu campaign every year but I must stress that this is a team effort and therefore, the award belongs to us all.” She was nominated by her colleague Susanna Niblett, Senior Occupational Health Nurse Advisor, on behalf of her colleagues in Occupational Health. Susanna said: “Every year I see Tracy coordinate the flu programme, which can be a thankless task.

“However, this year especially, she has thrown so much into it and gone above and beyond. “She has been involved in everything from developing a video to train flu vaccinators to collecting the data of those vaccinated. “She has even been putting in the hours of her own time, including sewing the flu bugs used in the video. “She has thought of so many ideas, and is already preparing for next season.” Thanks to everyone who had their flu vaccination this winter!

(From left) Karen Westwell, Occupational Health Secretary, Susanna Niblett,Senior Occupational Health Nurse Advisor and Tracy Lees, Occupational Health Nurse Manager.

Corporate and General News

Heartbeat - March 2014

Interest in Trust’s Dementia friendly wards grows THE strides taken to make SWBH Dementia friendly have been acknowledged by three visitors to the Trust. Mary Latter, Joint Commissioning Mental Health Manager (Dementia) for Cross City Birmingham CCG and Diana Coley and Val Smith, Day Centre Officers from Beeches GOLDD, came to City Hospital to visit our newly enhanced wards and areas for Dementia on February 26. They were inspired to visit after seeing a presentation that was made by Estelle Greenwood, Project Facilitator and Diane Rhoden, Adult Lead Safeguarding Nurse to the Birmingham Care Development Agency in January. Estelle, Diane and Paul Scott escorted the visitors around the hospital to view the wards that have already been enhanced under the dementia project (D11, D26, D43) along with the recent upgrades for D12, D17 and the 2nd floor chapel corridor. A&E main reception at City, the mental health room and some of the bays within the A&E Department have also been enhanced recently. Work is continuing with Sandwell site, Rowely Regis and Leasowes Care Centre and is due to be completed by the end March 2014. Mary said: “It was very interesting to see the developments in place on working wards and how they improve the feel of the ward for the patients. “I hope other hospitals will start to buy in to the principles you are promoting around the Dementia friendly environment.”

Diana said the digital orientation clocks were of particular interest to them as a care home, as patients can recognise where they are staying and being cared for as well as telling the time and date in various formats. She said they will be replicating this and other features at their care home in Great Barr. Estelle added: “There were challenges involved in enhancing the environment for D12 and D15 as these are “live” wards and we had to work around the patients and staff. “However, one change included putting up bed board pictures above each patient’s bed. “The patients are given the opportunity to choose an image that they can relate to, which moves with them should they have to go to another bay. “Patients were commenting on these as soon as they were given these pictures which stimulated either a personal memory or a hobby.”

Estelle Greenwood, Paul Scott, Mary Latter, Joint Commissioning Mental Health Manager (Dementia), Diana Coley and Val Smith, Day Centre Officers at Beeches GOLDD, with pictures of filmstars.

Working hard to treat sepsis

SEPSIS is one of the UK’s biggest killers in hospitals, so SWBH has been working hard to try and improve the diagnosis and treatment of sepsis within the Trust. With the release of the NEWS adult observation chart, a new version of the adult sepsis care bundle was issued by the Surviving Sepsis Committee. This latest version combines the sepsis screening tool with the Sepsis Six Pathway, severity assessment tool and antibiotic guidelines. Dr Roger Stedman, Medical Director, said: “Sepsis is one of the commonest causes of death in hospital, we need to get better at recognising it and intervening in a timely way, because every hour that we fail to recognise someone with sepsis increases their chances of death by 7.6 per cent.” Paul Drew, Trust Sepsis Nurse, has been working with staff on the wards to increase the use of the bundle and every member of the Sepsis Committee has been

educating the junior doctors in the diagnosis and management of sepsis. Dr Natasha Ratnaraja, Consultant Microbiologist, said: “Sepsis kills more than 37,000 people in the UK every year; that's more than deaths due to lung and breast cancer combined. Audit of the use of the care bundles has shown that in 66 per cent of cases of sepsis, the care bundle has been started, and completed in 30 per cent of these cases. This is an improvement on a previous audit which showed completion of the care bundle in only 18 per cent of cases of sepsis where the bundle was started. However, the aim is to use and complete the care bundle in 100 per cent of cases of sepsis. Help us beat sepsis; use the 3 Ss: Suspect sepsis Screen for sepsis Start and complete the sepsis six

Linda is on a QUEST

Deputy Chief Nurse, Linda Pascall, is on a quest to motivate healthcare professionals to be the best they can be to improve patient safety. QUEST (Quality, Understanding, Experience, Safety Training) is an online learning tool which can be accessed from all Trust computers featuring ten competency based modules. The certification is available for both registered nurses and healthcare assistants with the choice to pick and choose the modules that are applicable to your role. Although QUEST is not a mandatory training requirement it provides a perfect opportunity for nurses to continue with their professional development. Linda said: “QUEST provides the opportunity to stop and think about why we do things in a certain way and the impact that this could have on patient safety. “It’s a great annual refresher to help keep your skills and knowledge up to date.” Andrea Browne, Healthcare Assistant in Stroke Services, has completed all modules applicable to her role this year. She said: “E-learning is a good

way of learning for me; it meant I could work at my own pace. “Completing the modules has enabled me to learn new things and has motivated me to want to continue learning.” The evidence based questions in each module are created by specialist nurses in the following areas: Dementia, Nutrition, Safeguarding, Pain, Diabetes, Tissue viability, Medicines management, Moving and handling, Infection control and Intravenous drug and fluid administration. Each module provides links through to information to help with the learning process such as national guidelines or Trust policies. So if you are interested, join Linda on her quest and sign up by searching for QUEST on Connect.

Andrea Browne and Linda Pascall show off their QUEST certificates

Golden oldies!

2014 is a year of celebration as Birmingham and Midland Eye Centre reaches 190 years, Sandwell General Hospital reaches 130 years, City Hospital reaches 125 years and Rowley reaches 20 years since their official openings. Along with these significant construction milestones a communication milestone reaches its golden year in 2014: The Corridor, Dudley Road Hospital’s newsletter, was launched 50 years ago! From its inception in spring 1964 The Corridor welcomed letters from staff in a ‘Your right to be heard’ style, something its modern day counterpart, Heartbeat, continues to this day. Chairman Dennis Howell remarked in its first pages that The Corridor “should help us all at DRH to appreciate each other’s contribution and to promote a

first class atmosphere.” To celebrate its golden anniversary the newsletters have been made available at: swbhengage.com/ featured/history/city-hospital/corridor-newsletters/

Corridor at City Hospital.

New early warning system will save lives A NEW VitalPAC early warning system, which could save hundreds of lives across the Trust a year, is set to go live in one ward as Heartbeat went to press. The system allows nurses to enter vital signs at the bedside (including pulse, temperature and blood pressure) electronically on iPods rather than using a paper chart. The first ward to receive VitalPACS will be D17 with others following on as the roll-out progresses to 25 wards in total across Sandwell and City Hospitals. Dr Jon Hulme, Chair of the Resuscitation Committee, said: “This will be an extremely useful tool to help staff in clinical areas correctly check patients’ vital signs. “This can then lead to an immediate alert and

reviews by more senior clinical teams in a prioritised, robust fashion which is extremely important to ensure safe, efficient, rapid emergency care for our sickest patients.” Helen Cope, Lead Resuscitation Officer, added: “VitalPACS is an established tool already used successfully throughout the country. “It allows for early recognition of the deteriorating patient and promotes accurate and safe escalations of care for the patient.” Product demonstration roadshows will be taking place so staff can learn more about the technology on offer. The Trust has been successful in securing £576,000 from the Department of Health’s Safer Hospitals, Safer Wards Technology Fund to roll-out the system.

Your Right To Be Heard

Heartbeat - March 2014

We’ve asked YOU for your views, concerns and suggestions on how to improve the Trust’s services or your working lives. In each edition of Heartbeat we promise to publish your letters, plus their responses. Please note letters may be edited.

DEADLINE FOR SUBMISSIONS: Monday 14 April 2014

Stressed when searching for stress tool Dear Heartbeat, Why isn't the stress assessment tool available electronically? Firstly you have to find the assessment tool at the end of the stress policy, and then it has to be completed manually, and then scanned into the computer before being sent electronically! This is time consuming and not very lean. Kind regards, Tina Jackson, Service Development Manager, Sandwell Community Health Care Services. Dear Tina,

Please send your letters in less than 200 words to: Communications Department, D29, City Hospital or by email to: swb-tr.SWBH-GM-Heartbeat@nhs.net

Safety review ordered at Sandwell entrance Dear Heartbeat, I work in the MEC and regularly (multiple times a day) see service users pull into the driveway that leads off Hallam Street to Sandwell Main Reception and then panic when they see the barrier to the car park. Most then use the space to turn around and illegally drive the wrong way back out again. I have just a second ago seen a driver pull in, get confused and then park on the red double lines/pedestrian crossing while he gets out to study the site map on the corner. I can’t count the number of near-misses I’ve witnessed as drivers do confusing and often illegal manoeuvres. I wonder if there is anything that can be done to make the entrance clearer? It almost needs a big ‘its ok, the car park is this way’ sign! Concerned staff member.

You can find the information on the following link http://connect. swbh.nhs.uk/Corporate-Directorates/WorkForce/Human%20 Resources/Pages/Stress-at-Work.aspx

Dear Concerned staff member,

or by searching for ‘stress risk assessment’ on Connect.

Thank you for your observations, I agree with your assessment that it can be confusing especially for first time visitors. I will arrange for a review of the area to be undertaken to see if we can improve the overall safety of the entrance.

Lesley Barnett, Deputy Director of Workforce.

Steve Clarke, Deputy Director of Facilities.

How to feel like a Priced out of the canteen celebrity Dear Heartbeat,

It was wonderful to see an advertisement to celebrate the Chinese New Year by visiting the Hallam Restaurant and having a Chinese meal.

Dear Heartbeat, How do you make a boring, plain but very patriotic ward clerk feel like a celebrity? The answer is simple nominate them for the “Employee of the Year”. From August 2013 up to the present moment I have had a brilliant time with people really taking interest in the nomination, voting and the awards process. I have had lots of fun joking with staff about my “official duties” and I have had some lovely messages of congratulations from lots of people, including some staff that I worked with when I joined the NHS in 2000. So I am writing this to say thank you to everyone for enabling me to feel very privileged, because I know that there are lots of staff that are very deserving of this award and I have been very lucky to be nominated and then have so many people take the time to vote for me. I also really enjoyed my role judging the Christmas decoration competition. So THANK YOU and long live the NHS and may we continue to serve the taxpayer in such an excellent manner for a long time to come! Angela Hook, Ward Clerk, D25. Dear Angela,

Unfortunately, as I am a member of our lower pay band staff the cost of food was way beyond my budget, for example a chicken curry with rice was £4.45. I have over the last few years used our canteen facilities less and less because of the increasing costs, a simple sandwich is now over £2. I believe the canteen food is of excellent choice and standard but because of ever increasing charges I can no longer use this facility. Our staff discount has been lowered and lowered and it is now hardly worth having. If prices continue to increase the canteen will only be used by our higher paid staff and then will go into decline and we could lose this facility which is a great shame, do you think we could review the pricing structure and try to introduce some real cheap hot food options? I really miss eating a hot meal at lunch time but the cost of a hot meal is totally beyond what I can afford. I hope we can review this situation and make it more affordable for our lower paid staff to continue to use this wonderful facility. Many thanks. Anon. Dear Anon, Thanks for your letter. We do keep prices under review and our Public Health Plan means that in future we will differentiate our prices in part based on the healthiness of the food – healthier will be cheaper!

Thanks for your note. I am not sure your official duties are over until October 2014 and the next ceremony. I really hope your note inspires others to nominate colleagues for our awards when we launch in the spring.

In general our food prices are competitive and the produce reflects our commitment to quality and maintaining standards. There are daily meal savers available and our sandwich prices range from £1.95 to £2.25. We clearly have work to do on the clarity of our pricing though - the actual price of the Chicken Curry with basmati rice inclusive of staff discount was £3.53.

Toby Lewis, Chief Executive.

Steve Clarke, Deputy Director of Facilities.

Heartbeat - March 2014

Your Right To Be Heard

Agile working comes under question

Sickness is monitored

Dear Heartbeat,

I am not talking about people with genuine reasons to be off (a genuine illness); I am on about the ones who are clearly abusing the system. Some are even doubling the annual leave they are entitled to each year by doing this.

We hear a lot about leadership and values in the Trust. If leadership starts at the top why are our directors using their own offices at Sandwell now? What happened to agile working like the rest of us? If the workplace and its workforce is supposed to be a reflection of the Trust’s brand and values it’s no wonder that the staff feel so demoralised and are so disengaged with the Trust. We certainly aren’t valued! We are treated like battery hens, it’s impossible to concentrate or take confidential phone calls and coming to work is no longer an enjoyable experience but something we have to endure. Other than saving money, which we all have to do, I can’t think of a single positive thing to say about agile working. How did our unions let this happen?

Dear Heartbeat, Can someone tell me why it is this Trust tolerates so much regular sickness from some people who abuse the system to the full. These are the people who regularly every month take days off sick for one thing or another. Some of them are so regular they become predictable and never fail in doing it.

These people obviously do not care about their colleagues as they leave their workload for someone else to cover for them while they are away. People here work hard enough to maintain efficiency without being dragged behind by people who would rather get paid to sit on their backsides at home or take a day out on top of their annual leave entitlement.

An unhappy member of staff.

Let’s face it, it is made far too easy in the Trust for these people to get away with it on full pay on a very regular basis. It’s always the same people and they are taking the mickey out of all the hard working staff here who do turn in everyday, who work for their pay and who end up having to work even harder to cover ‘the regulars’. It is a joke and something should be done to stop it.

Dear ‘unhappy member of staff’,

Like I said, these are the ones who abuse the system to the full, not the people who have real sickness issues who really cannot help it.

Sorry to hear you feel this way. The estates rationalisation programme has successfully closed a number of poor quality buildings, allowed the opportunity to bring various teams together in one place and (as you note) saved a great deal of money without impacting on patient care. The agile working element has introduced new ways of working for many of us. At times these do have their disadvantages but they have to be weighed against the benefits outlined above. You are not right that executive directors have dedicated offices. They and other staff have bookable office space for private work – cellular space in the jargon. That is one of the changes to agile that we are introducing based on feedback over the last nine months. We are in the process of moving Trust Headquarters to Sandwell. We have made that decision because we wanted to ensure there are senior leaders on each acute site. We also know that that space will be being used in four years’ time. We need now to begin a process of moving non-clinical departments onto the Sandwell site. We do not believe that using PFI estate for those functions is the right way to go. Graham Seager, Director of Estates and New Hospital Project Director.

Fed up. Dear colleague, We are all I think working hard on this. Some teams have seen big reductions in sickness levels. With staff-side colleagues we have agreed a series of actions to tackle both short term and longer term sickness. To mention just two: We will be investing in more support for mental health issues among our workforce. And we will be looking to locally publish sickness data, because we know that publishing data within teams does change patterns of single day sickness. Lesley Barnett, Deputy Director of Workforce.

Cleaning programme to be reviewed in toilets Dear Heartbeat,

Difficulty unscrewing ‘hygienic’ water bottles Dear Heartbeat, We are writing in regards to the water bottles supplied on the wards. Patients are struggling to open nearly every bottle of water as they are very difficult to screw open. Staff are also struggling to open them too, causing repetitive strain on their wrists. Kind regards,

Is there a protocol that should be adhered to for how often visitor/staff toilets should be cleaned? The toilets that we have to use are never in a clean state. It ranges from no toilet roll or paper towels, to there being no soap and even on a few occasions there seemed to be blood all over the sink! Are these acceptable conditions to leave the toilets in considering we get numerous emails about hand washing and norovirus? Well, it’s no wonder why these germs spread if the facilities are not cleaned on a regular basis. The last time the paper towels and soap had ran out, I called the telephone number displayed on the wall in the toilets to report it, and still 24 hours later no one had been so I called again, eventually later that day, someone did come and replaced the soap but the toilets and the surrounding area did not look (or smell!) like they had been cleaned! On the subject of the smell, would it not be possible to have air fresheners on the wall to try and combat the inevitable smells. I personally think, as possibly hundreds of people use these toilets on a daily basis, they should be looked in 1-2 hourly and certainly cleaned twice a day! A concerned member of staff.

D27. Dear concerned member of staff, Dear Colleagues, Water bottles are provided on wards to ensure patients always have a source of drinking water and from an infection control point of view the bottles are more hygienic than having water jugs and glasses. I am genuinely saddened to hear that staff feel that this best practice is causing a problem for them, but would urge any staff member who is concerned about repetitive strain injuries to seek advice from the Occupational Health Department. Colin Ovington, Chief Nurse.

Thank you for raising your concerns in relation to the frequency of the cleaning service to the Trust toilets. The frequency and level of service is determined by a number of factors relating to; location, frequency of use, clinical functionality and the national standards of cleanliness, a designated routine cleaning schedule is then applied. It is clear from your comments that the service to the area that you are referring to is falling below an acceptable standard, it would be very helpful if you would email janetclarke3@nhs.net and provide the location details so we can review the cleaning programme. Steve Clarke, Deputy Director of Facilities.

SWBH Heroes

Heartbeat - March 2014

Celebrating our SWBH Heroes SWBH is full of remarkable, motivated people, who give a lot to our communities. Over the last few months some of them have been featured in free newspaper the Sandwell Chronicle and here they share their stories with you.

More NHS Heroes including Pharmacist Julie Brooks, Colin Holburn, A&E Consultant, can be found on the Communications pages of Connect. If you would like to nominate a colleague as an SWBH NHS Hero please contact vanya.rogers@nhs.net

Matron Julie Romano WHAT do you do when a ward in your hospital is failing? Staff sickness rates are up, vacancies are difficult to fill, personal development reviews are not completed, patients and their relatives are not happy and six out of seven national standards are not being met. Bring in Matron Julie Romano – one of the first nurses to achieve the gold standard of the Trust’s ‘Nursing with Pride’ awards. More than a breath of fresh air, Julie is a powerhouse of determination, a nurse with a vocation, who cares about the patients she is responsible for and the families they love. Coming from a background in retail management, Julie recognised her calling to care and abandoned the material trappings of the world of retail to study nursing nearly 13 years ago. In 2012 Julie took up her first matron’s position in Sandwell Hospital’s Priory 2 ward, and literally turned the ward around with her inspirational leadership style. She explained: “When I took up my role I knew it wouldn’t be easy, so I looked at where things were going wrong. “I had one-to-ones with all my staff and realised that there was no perception that the ward was failing. “Studying closely it was obvious that staff were doing the right things and patient care was a priority, however it was in the details that we fell down, so that was obviously the

place to start. “I instigated a set of motivational changes at rapid pace, which meant that every week for 12 weeks we made three changes.” What that meant for patients was a highly skilled and energetic multi-disciplinary team dedicated to their care, and a transformed environment, not least of which is a new dining room where patients are encouraged to eat their meals in a social setting. A weekly Matron’s Clinic and daily ‘Visibility Round’ ensured that patients and relatives had opportunities to raise any concerns or pass on compliments. The result of all the changes was that after three months complaints about the ward stopped completely and there have been no complaints about the standard of nursing for over 12 months. Julie added: “It has been hard work, but immensely satisfying.”

IT WAS a scene any disaster movie could claim - the powerful cab of an articulated HGV, smashing into a parked car, dragging it up the road, before crashing through railings. Momentum hurled it up a grassy slope to plough straight through the wall of a hospital, ending up in an elderly patient’s bathroom. But this was no Steven Spielberg epic, no episode of Casualty or Holby City, this was reality – the actual event that happened at Leasowes Intermediate Care Centre, only a few weeks ago. The centre had 20 inpatients when the crash happened. Many staff were called upon to help the Trust continue to provide care, and one in particular - Admin Manager Lesley Wall stepped up out of her comfort zone to help with the response. As Chief Operating Officer for the Trust, Rachel Barlow arrived on scene to establish a silver command centre to deal with the immediate response, there was no trained loggist on site. It is a legal requirement to log every decision and action, so Lesley was asked to take on this essential role.

She explained: “I take minutes for meetings so I know about accuracy and speed, but a loggist is a specialist who must record everything to be signed off by the silver commander at the time. “It is a very important role and crucial to get right. “Although it was a period of high drama, everyone worked extremely efficiently, putting the patients first, so their care could continue as seamlessly as possible. “It is frightening to think of the potential casualties we could have been dealing with. “I heard that the car that was hit first belonged to a carer who had stopped to visit a patient. “Apparently she got out of car at 7.15am and the lorry hit just seven minutes later. “At the time it happened, patients would have been in their bathrooms, it was just lucky that the patient in that bedroom was not using her en-suite at the time.”

Lesley Wall.

Ruth Williams, Manager Integrated Care Service

Matron Julie Romano.

Dr Muninder Lotay, Clinical Lead, Homeless Patient Pathway WITH homelessness a growing problem in the UK and figures in our area double the national average, SWBH has teamed up with other health providers and partners to offer life changing help to those who need it. Enter our local NHS hero Dr Muninder Lotay who is clinical lead for the Homeless Patient Pathway. Dr Lotay, who works as our GP link, explained: “For those who are homeless life expectancy is almost thirty years less than the UK average for those with a permanent roof. “Often difficult and unpreventable circumstances have made them homeless which in turn places their health at serious risk. “The homeless are unique in that they often suffer with physical, mental and social ill health at the same time. “Homeless patients discharged after their physical problem is healed often come back to hospital again and again. “This is known as the revolving door syndrome. “Ensuring that we address the mental health and social circumstances of such patients on admission ensures a holistic approach and safeguards against deterioration of health on discharge and subsequent readmission. “Knowing that with committed effort I can make a difference to improve the life of another drives me to do the best I can. “Over time, in the grand scheme of things,

Admin Manager Lesley Wall

I have realised that the life changing event of going from housed to homeless is only a step away. “Had I not had the overwhelming support of loving parents and a well-structured society when it mattered, I genuinely believe I too would be homeless.” Dr Lotay presented at the recent SWBH event ‘Raising the Roof for Homelessness’ where he detailed the journey so far in the project to help the homeless. He advised: “Statistics have shown that the Homeless Patient Pathway has reduced readmission rates for patients who have been frequently admitted to hospital.”

Dr Lotay.

Ruth Williams, who manages integrated services in the community, takes daily delight in her role helping people to get back to the life they want to live no matter how long it takes. As manager of ICARES she works with nurses and therapists to help patients recover after illness such as a fall, stroke or Parkinson’s. She explained: “My aim is to ensure our patients have everything they need to help themselves for the rest of their life. “We try and stop people coming into hospital if there is a better place to treat them, and we can also see people as soon as they leave hospital to ensure they don’t have to go back in. “We will try and help the person get back to activities they want to do, which may be walking outside, going to the pub or enjoying their garden. “As a one stop service for people at home, we try not to pass patients around services unless we agree with them it’s the right thing for their care. “We don’t see people forever, as we equip them to look after themselves, by providing the support they need to live independently, but we will always see someone again if they need us.” Training as a speech and language therapist 20 years ago, Ruth started working at Rowley Regis Hospital in the early 90s, where she set up a self-help group for people with communication problems (Speakability)

that to this day still meets every month. She was also instrumental in setting up then redesigning the speech and language service, so it is now a nationally recognised speech therapy rapid response service. Working right across Sandwell, the ICARES service covers every person who has a Sandwell GP, including those who live in care homes. Ruth recalled: “I remember the first lady I helped to stay at home at the end of her life rather than going into hospital to die. “Her family told me later she was surrounded by her family, it was peaceful for both her and her family.”

Ruth Williams.

Heartbeat - March 2014

Welcome and farewell! WELCOME to the 201 new colleagues (175 full time equivalents) who joined the Trust in December, January and February. Farewell is wished to the 187 staff (159 full time equivalents) including 37 retirements (30 full time equivalents) who left during December, January and February. Thank you for your service and all the best for the future!

A real achievement FAMILY and colleagues joined Muriel Hamilton for a send-off into a relaxing retirement. Muriel, a Staff Nurse at the Birmingham and Midland Eye Centre (BMEC), has worked for the NHS for 34 years, with 25 of those at SWBH. Muriel said: “Now looking back on my career it feels like a real achievement.” Natalie Simon, Staff Nurse, Eye Day Surgery, said: “Muriel is a joy and inspiration to work with. “She is a caring and kind individual who will be greatly missed.”

Sister Natalie Simon joins Muriel’s sister Dorothy Brooks to wish her well on her retirement

Senior Staff Nurse retires after 42 years A SENIOR Staff Nurse has called it a day after 42 years at City Hospital. Arlene Hawthorne was sent off in style with a cake and flowers at a leaving do in the staff room of the Adult Surgical Unit in the BTC. Arlene said: “I have loved it, I love nursing. “To me it’s not a just a job, I come into work and get paid for talking to patients all day. “The bond between the nurses at City Hospital is really strong and is better than anywhere else I have been.”

Say hello, wave goodbye.. Spotlight on our new starters… New Non–Executive Director Designate joins the Board WELCOME to new Non-Executive Director Designate, Mike Hoare who joined the SWBH Trust Board at the beginning of February. Mike, from Redditch, has been appointed to the new role of non-executive director designate, which is a fouryear, non-voting role, but enables the Trust to harness Mike’s considerable skills and experience in IT and change management. Mike is a highly accomplished senior executive with experience operating at board level in his job as Director of Multi Service Integration at information technology solutions company Fujitsu, where he has worked since 2006.

Joining the jet-set WELL-KNOWN C o n s u l t a n t Ophthalmologist, Pangiota Stravrou, was given a special celebration party at BMEC recently where she celebrated 26 years of NHS service to the Trust. Miss Stavrou will still be doing a monthly shift at BMEC but will be flying in from her home town of Athens

where she is going in to practice. Miss Stavrou said: “I think BMEC is definitely one of the best units in the world and it has been a privilege to work here.”

Mike Hoare.

Yorkshireman Tony brings ‘straight talking’ and ‘ honest values’ TONY Waite joined the Trust as our new director of Finance and Performance Management from his previous role at Burton Hospitals Foundation Trust. He said he was truly delighted to be at SWBH and could not have been made more welcome. “The Trust has a very clear direction, bags of ambition and a palpable determination to succeed,” Tony added. “That is exciting, motivating and I look forward to playing my part to the full in our journey to success.” Tony has worked in the NHS for 23 years, 18 of those as finance director.

“I have toughed it out through financial turnaround and enjoyed the realisation of two new hospitals when some said it couldn’t be done,” he said. “I am a Yorkshireman, my sporting passion is rugby league and my team Wakefield Trinity. “Straight talking, honest values and team work matter a lot to me and I will bring that to my job here. “The West Midlands is a new part of the world to me and is a new adventure for me and my family. “So far so good. It is great to be here and I really look forward to working with you.”

Curtain call for City Hospital nurse after 36 years A gathering of friends and colleagues said goodbye to muchloved Marie Gilbert as she retired after 36 years’ nursing service at City Hospital in January. Marie started work as a HCA in 1977 at what was then Dudley Road Hospital, moving to D25 after she qualified. Later she went to the CCU for a one month trial, and has remained there ever since! Marie continued to study and advance through the ranks, becoming Ward Manager in 2002 and Acting Matron in 2012.

Marie said: “I have happy memories of a fantastic 36 years in nursing.” Her future plans include never spending any winter months in England, enjoying quality time with her family and developing a cake empire!

AFTER eight and a half years as the Trust’s Director of Finance and performance Management, Robert White left the Trust in January to start a new position at the national Audit Office. Tony Wharram, Deputy Director of Finance, said: “Robert wouldn’t want to claim the credit for himself but he should bask in the glory to some degree, we have gone from deficit to surplus during his eight and a half years at the Trust.” Robert said: “I wish the Trust and Tony (Waite - the new Finance Director) every success in future because across the country the challenges

Welcome: Steve Smith THE Trust would like to welcome Steve Smith to the Membership and Engagement Department. Steve joins the department as Community Membership Administrator after previously working with the Estates Rationalisation Project. His duties are to support the work of the Membership team by arranging events, doing community visits, as well as keeping the vast membership database up to date. Steve said: “I really wanted to get involved with the community element of the role when I applied for the job. “I am looking forward to building relationships with our local community. “This is a different

challenge but a positive challenge. “It is something new that I have to learn, but it has been nice working with Jeannette Howes and the team.” Jeannette Howes, Engagement Manager, said: “Steve has been a great help since joining us over the last couple of months and we look forward to him helping us as we build our membership.” The Membership and Engagement team are focussed on looking after and involving the public members in the Trust’s bid to gain Foundation status.

Steve Smith.

Retiring from Community nursing ONE of the Trust’s longest serving community nurses has hung up her uniform recently to enjoy and actionpacked retirement. Polly Dowe, aka Miz P, started her nursing in 1980 at Sandwell Hospital, from where she went on to work within ward settings and then the community, working as a District Nurse and finally as a School Health Nurse. She said: “As a well-trained practitioner and a competent nurse, delivering appropriate care and with a commitment and compassion for each individual, my career has given me great satisfaction.”

Polly Dowe.

"Bye Bye Bev" say colleagues Beverley Richards and Marie Gilbert

Goodbye from Robert White Arlene Hawthorne and Donna Jones.

facing not just this Trust, but all parts of the NHS are set to continue. “The Trust does of course always find a way through its challenges and sometimes out of adversity it has become stronger, so I remain optimistic. “It has been a privilege to work at SWBH. Keep up the good work!”

Robert and Tony Waite

INSPIRATIONAL nurse, Sister Beverley Spence, retired in January after training and working at the Trust since 1978. Bev, who was a specialist stroke alert nurse, celebrated her retirement on her ward, Priory 4. After working as an auxiliary nurse for 21 years, Bev made the decision to take her career to the next level when she was in her mid-40s and qualified when she was 48. Since then she has made it a vow to encourage others to expand their horizons and do the job they want to do.

Beverly Spence, says goodbye to the Trust after 36 happy years.

Apology and Correction HEARTBEAT would like to apologise after mistakenly using the wrong photograph of Brian Hurst, Vice Chairman of Sandwell Hospital Radio, when reporting his death in the last edition. The photograph was of Barry Balmayne, the first station manager of Sandwell Hospital Radio. Our sincere apologises to both Barry and Brian’s family.

Brian Hurst.

Hold the back page

16 Heartbeat - March 2014

Heartbeat - March 2014 16

Becoming renowned as the best integrated care organisation in the NHS... Guest editor, Toby Lewis, shares stories from across the Trust of teams delivering our strategic mission.

@TobyLewis_SWBH

What’s in a name?

IN February we got to show off, ever so slightly. We hosted our Ambulatory Emergency Care Conference. Inviting experts from elsewhere to come and listen to our teams present the work that has been done in both City, Sandwell and Rowley Regis over the last few months. Work to change the pathway of care for patients coming to A&E departments or needing urgent assessment after seeing a GP. Ambulatory is not, let’s be honest, the most userfriendly world in NHS-speak. It refers to patients who typically are mobile and often can be looked after on an outpatient or day-stay basis. Maybe after a period of observation and tests. We know that being admitted to hospital carries its own risks, and can start a process of being institutionalised and isolated from one’s friends and family. So if we can provide care without admission that is, in many cases better care. In September 2013 we invested to support a big expansion of services in City MAU. In November, we made more changes, this time at Sandwell to create a purpose area on the first floor above ED. And in January we opened our primary care assessment and treatment service at Rowley Regis, alongside local GPs, led by our ICARES service. All in all a statement of intent that

we want to make these changes at scale. Indeed, the number of patients using our services appears among the largest in the country. There is a lot done, and a great deal left to do to make this model of care our standard, seven days a week. Ensuring joined up-integrated care with local GPs and our own community nursing and therapy teams. Not being in a bed should not put you necessarily down the queue to get diagnostic tests or extra help. But the greatest success we can point to so far is the most important one: a jump of 25 per cent in the number of patients using our service who would recommend it to others – just nudging into the 90s.

Dr Jo Lennie, Carolyn Robertson, Nathalie Richard, Toby Lewis and Nuhu Usman.

Safer up north? THERE are some great indications of safety at our Trust. Whether it is the lowest mortality rate in Birmingham or our pressure ulcer campaign. We know too there are some signs of worry; readmission rates for adult emergencies at Sandwell and five Never Events in 11 months. In response to our third and fourth Never Event I asked for external help with safety. Not to audit us again. But to help us understand a safe culture, and which teams in our midst could evidence that now. That is how many of us found ourselves at the Bethel Convention Centre in Sandwell, undertaking a culture

test – using the Manchester Patient Safety Assessment Framework or MaPSAF. What became very quickly, very clear, is that it is often at the boundaries of teams and processes that we lose sight of safety. We know what we know. We do not know what someone else might know. And a safe culture gives us encouragement and permission to ask questions that tackle those issues. Over the next year we will try and use this tool widely within our teams. It has to be at team level. Because as the CQC tell us very few trusts are all high achieving or all low performing. There is a mix. We need to know our own mix and work

out how to make the best of what we do in the Trust, what we consistently do in the Trust. The risk team, headed by Allison Binns, would be happy to talk to you about it. It is a simple way to help a group of people to talk honestly about what works and what does not work. Then the team, and those around them, including the Board (our Chairman is pictured) have to act on the results. We will.

Delegates at the Safety summit.

My Life – information and advice for patients DR ANNA Lock and Kate Hall presented the Trust’s Palliative Care Service to March’s Trust Board meeting. The uplifting story that they shared might surprise some readers, as it did some of us listening. Over the last two years services have improved greatly. Palliative care length of stay has reduced. Support available to patients and to staff caring for them has improved. But we know that issues remain with home oxygen supply for people beyond our immediate borders, and with the completeness with which we include families and others in Do Not Resuscitate documentation. More than half of the deaths each year in our hospitals are deemed to be anticipated. That suggests that we have the opportunity to support our patients and, in many cases, to help them to die in a place of their choosing. If we cannot integrate the care we offer this group of patients; integrate care with their GP, with their family and with others; then we are missing a huge contribution that we can make to the whole community that we serve. How we look after those who die is an important test of our mission. During 2014 we will begin to review the last year of care that we provide to those who die with us. This is an extension of our awardwinning Mortality Review system. Initial studies suggest that in a lot of cases opportunities may be missed to get expert help with the care of someone who is likely to pass away. Like a lot of the work that we are doing now to improve services, the test is less whether we have the expertise in house to help, and more

our skills in connecting the needs of a patient with the talent we have within SWBH and the wider system. Crucially, this means that we need to recognise the patient first, and the presenting condition second. We have in writing and on-line information to help you and your patient, in the form of the My Life booklet. That prompts key questions that need to be asked. And provides some help with the very many services we have locally which can assist.

Dr Anna Lock and Dr Mike Biaber.

Are you one in 700? Did you get a letter from the Trust during March to your home address? It was to remind you to have your appraisal before April starts. Please do not ignore it. Act on it. Appraisal is vital. It connects you with the Trust. Nine of ten colleagues at SWBH have had their appraisal. Time to join the club.

NICK'S LAST WORD... YOU may have heard talk nationally around the need for closer integration between health and social care, and I am sure in your day to day roles as health professionals you come across challenges because of the different ways health and social care are set up. In June 2013 the Government announced plans to integrate health and social care by creating pooled budgets between Clinical Commissioning Groups and local authorities. Nationally, from 2015, £3.8billion will be transferred from existing NHS budgets to local councils to support health and social care. This is the biggest ever

financial incentive for councils and local NHS organisations to jointly plan and deliver services, so that integrated care becomes the norm by 2018. First and foremost, the Better Care Fund (BCF) brings our ambition of “healthcare without boundaries” one step closer to becoming a reality. Ultimately we know there is no new funding to deliver BCF, so we must ensure that the BCF will deliver savings through reduced demand on hospitals. This was a key part of the Government’s thinking behind BCF. For the BCF to be a success and reduce demand on our hospitals, I am convinced we need to engage with and support our local communities to

act as the drivers for change. Each community is different and has its own unique challenges, and by refocusing the CCG to work at a community level we can help drive this change. Through our work in redesigning community nursing we recognise there are around 35 distinct communities. In developing the BCF we will now be refocusing the CCG at this community level with GPs taking the lead to develop local strategies to improve the health and wellbeing of their communities and ultimately reduce demand on hospitals. The BCF will launch by 2015, and we will need to move quickly

to start delivering the necessary change at a local level. Over the next three years we will work closely with our clinical leaders to carry out an intensive programme to deliver change. A dedicated community collaboration team will work with GP practices, NHS and council services and voluntary and community networks to review the local needs and identify the individual strategies to improve health and wellbeing. This is a new way of working for us, and we recognise that we cannot achieve these objectives alone. We will need to work together as a health economy to deliver our aims of closer integration and community led healthcare.

Nick Harding, GP and Chair of Sandwell and West Birmingham Clinical Commissioning Group.